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❑ Keller Canyon <br /> y ❑ Ox Mountain ; ❑ Newby Island ❑ Forward <br /> Sanitary Landfill Sanitary Landfill Sanitary Landfill Landfill <br /> 901 Bailey Road 12310 San Mateo Road 1601 Dixon Landing Road 9998 S Austin Road <br /> Pittsburg,CA 94565 Half Moon Bay,CA 94019 Milpitas,CA 95035 Manteca,CA 95336 <br /> Phone (925)458-9800 Phone(650)726-1819 Phone(408)945-2800 Prone(209)982-4298 <br /> Fax(925)458-9891 Fax(650)726-9183 Fax(408)262-2871 Fax(209)982-1009 <br /> __ NON-HAZARDOUS WASTE MANIFEST <br /> GENERATOR <br /> MaR Sanchez WASTE ACCEPTANCE NO. <br /> MAILING ADDRESS <br /> 1633 W Walnut Street <br /> CITY STATE,ZIP REQUIRED PERSONAL PROTECTIVE EQUIPMENT <br /> sto 03 <br /> PHONE ❑GLOVES 0 GOGGLES ❑RESPIRATOR ❑HARD HAT <br /> 0 TY VEK 0 OTHER <br /> CONTACT PERSON <br /> Dave Thl"PitAll SPECIAL HANDLING PROCEDURES <br /> SIGNATURE OF AUTHORIZED AGENT TITLE DATE <br /> GENP-RATOR S CERTIFICATION I hereby certify that the above named material is not a hazardous <br /> Wastecrl as defined by 40 CFR Part 261 or bile 22 of the California code of regulations has been property <br /> described t�assrfred and packaged and is in proper condition for transportation a-cording W apphcabie <br /> regulations AND If the waste Is a treatment residue of a Previously restricted hazardous wasto <br /> subject to the Land Disposal Restrictions I certify and warrant that the waste has been treated in RECEIVING FACILITY <br /> accordance with the requirements of 48 CFR Part 268 and is no longer a hazardous waste as defined by <br /> 40 CFR Part 261 <br /> WASTE TYPE <br /> 0 DISPOSAL 0 SLUDGE <br /> 0 CONSTRUCTION 0 WOOD <br /> O DEBRIS 0 OTHER <br /> 0 SPECIAL WASTE <br /> GENERATING FACILITY <br /> 1876 Country Club Blvd, Stockton, CA 95203 <br /> TRANSPORTER NOTES VEHICLE LICENSE NUMBER TRUCK NUMBER <br /> r� b <br /> ADDRESS r a /� <br /> L_ Del <br /> CITY SR <br /> 'aGitta <br /> PHON END DUMP BOTTOM DUMP TRANSFER <br /> SIGNAT THORIZED AGENT OR DRIVER DATE ROLL-OFFS FLAT-BED VAN DRUMS <br /> CUBIC YARDS <br /> I hereby certify that the above named material has been IS Yards <br /> accepted and to the best of my knowledge the foregoing DISPOSAL METHOD (TO BE COMPLETED BY LANDFILL <br /> is true and accurate ) <br /> DISPOSE OTHER <br /> REMARKS 0 SOIL <br /> 0 CONSTRUCTION <br /> FACILITY TICKET NUMBER DEBRIS <br /> ❑NON-FRIABLE <br /> SIGNATURE OF AUTHORIZED AGENTDATE ASBESTOS <br /> 0 WOOD <br /> 0 ASH <br /> 0 SPECIAL OTHER <br /> SCHEDULING MUST BE MADE PRIOR TO 3 00 P M THE DAY PRIORTO EXPECTED ARRIVAL•ANY UNSCHEDULED LOADS ARE SUBJECT <br /> TO REFUSAL UPON ARRIVAL ONGOING DAILY DELIVERIES MUST BE SCHEDULED WITH THE LANDFILL THE DAY BEFORE. <br /> GENERATOR COPY MANIFEST 0 52889 <br />